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SYIHABUDDIN ET AL. / Tropical Animal Science Journal 48(1):83-92p-ISSN 2615-787X e-ISSN 2615-790X
Accredited by Directorate General of Higher Education, Research,
and Technology, Republic of Indonesia, No. 225/E/KPT/2022
Tropical Animal Science Journal, January 2025, 48(1):83-92
DOI: hps://doi.org/10.5398/tasj.2025.48.1.83
Available online at hps://journal.ipb.ac.id/index.php/tasj
Copyright © 2025 by Authors, published by Tropical Animal Science Journal.
This is an open-access article distributed under the CC BY-SA 4.0 License
(hps://creativecommons.org/licenses/by/4.0/).
INTRODUCTION
Foot and mouth disease (FMD) is an acute and
highly contagious viral infection that aects cloven-
hoofed animals. Foot and mouth disease (FMD) is
caused by the foot-and-mouth disease virus (FMDV), a
single-stranded positive-sense RNA virus that belongs
to the genus Aphthovirus in the family Picornaviridae
(Jamal & Belsham, 2013). There are seven recognized
serotypes of the Foot and Mouth Disease Virus (FMDV):
O, A, C, SAT 1, SAT 2, SAT 3, and Asia 1 (Jamal &
Belsham, 2013; World Organization for Animal Health,
2018). Foot and mouth disease (FMD) can lead to
signicant economic losses, particularly for smallholder
farmers in low and middle income countries (LMICs)
(Thomson, 2003; Rodriguez & Grubman, 2009; Jamal
& Belsham, 2013; Food and Agriculture Organization,
2017; Santos et al., 2017; Adjid, 2020; Hopker et al.,
2021). This vulnerability arises from factors such as
the close proximity of animals on neighboring farms,
overcrowded markets, limited access to vaccinations,
and inadequate biosecurity measures (Campbell et al.,
2019; Sargison, 2020; Hopker et al., 2021; Win et al., 2021).
In Indonesia, smallholder farms account for over 90%
of livestock operations (Matondang & Rusdiana, 2014;
Widiati et al., 2019). The eects on these households are
compounded by declining incomes, increased time and
Evaluating Foot and Mouth Disease Vaccination Services through Assessment of
Beef Cale Farmers’ Satisfaction in Sleman Regency
M. Y. Syihabuddina, S. Andarwatib,*, B. Guntorob, & A. R. S. Putrab
aGraduate School of Animal Science, Faculty of Animal Science, Universitas Gadjah Mada
bDepartment of Livestock Social Economics, Faculty of Animal Science, Universitas Gadjah Mada
Jl. Fauna No.03, Karang Gayam, Caturtunggal, Kec. Depok, Kabupaten Sleman, Daerah Istimewa Yogyakarta 55281
*Corresponding author: andar_siti@ugm.ac.id
(Received 20-09-2024; Revised 25-11-2024; Accepted 26-11-2024)
ABSTRACT
The study aimed to evaluate the satisfaction of beef cale farmers towards Foot and Mouth
Disease (FMD) vaccination services in Sleman Regency. A survey method was employed, involving
120 farmers who participated in the FMD vaccination program. Beef cale farmers’ satisfaction levels
were assessed using the Customer Satisfaction Index (CSI) method, which revealed that 82.25% of
farmers were highly satised with various indicators of the vaccination services. To identify areas
for improvement, the Importance-Performance Analysis (IPA) was utilized. The IPA highlighted
several aributes as top priorities for performance enhancement, including: The priority indicators
for performance improvement include service procedures that are easy to understand, vaccination
ocers not discriminating based on farm location, the handling skills of the ocers, and the
application of biosecurity measures according to procedures. Beef cale farmers’ perceptions of the
benets of the vaccination program were 83.8%, indicating a rating of ‘very good’. These insights
oer a foundation for policymakers to optimize FMD vaccination services, increase beef cale
farmers’ satisfaction, and promote livestock health.
Keywords: customer satisfaction index; foot and mouth disease; importance performance analysis;
vaccination services
costs related to caring for sick animals, challenges in
sourcing replacement livestock, and emotional distress
from losing animals that are often valued as integral
parts of their families (Hopker et al., 2021).
Indonesia has experienced multiple outbreaks
of FMD since the disease was rst introduced in 1887
through the importation of cale from the Netherlands.
The last major outbreak occurred on the island of Java
in 1983, which was successfully eradicated through a
mass vaccination campaign. Indonesia was ocially
declared FMD-free in 1986 by Minister of Agriculture
Decree No. 260/Kpts/TN.510/5/1986, a status later
recognized by the Oce International des Epizooties
(OIE) in Resolution No. XI of 1990, following an
evaluation by teams from the OIE, FAO/APHCA, and
ASEAN (Directorate General of Livestock and Animal
Health, 2022). However, in Indonesia, a new outbreak
of FMD emerged in April 2022, which quickly spread
across the country (Food and Agriculture Organization,
2018; World Organization for Animal Health, 2018;
Directorate General of Livestock and Animal Health,
2022).
Eorts to control FMD and achieve a disease-free
Indonesia require eective strategies (Directorate
General of Livestock and Animal Health, 2022).
Established control measures include animal destruc-
tion, outbreak tracing, quarantine, movement restric-
84 January 2025
SYIHABUDDIN ET AL. / Tropical Animal Science Journal 48(1):83-92
tions, vaccination, import/export controls, and sanitation
(Kodituwakku, 2000). Vaccination is crucial for prevent-
ing large-scale epidemics, promoting herd immunity,
and protecting both individual animals and populations
(Rodriguez & Grubman, 2009). These initiatives enhance
the prosperity and food security of rural communities
in low and middle income countries (LMICs) by ensur-
ing healthier livestock, which increases agricultural
productivity and improves livelihoods (Fernando, 1969;
Campbell et al., 2019; Hopker et al., 2021).
Despite these eorts, vaccination services often
face challenges such as limited coverage, accessibility,
inconsistent quality, and costs to vaccination programs
(Yemeke et al., 2021; Nuvey et al., 2023), which hinder
eective FMD control, especially among smallholders.
This study addresses this gap by evaluating these
services from the farmers’ perspectives to identify
areas for improvement. While previous studies on
FMD vaccination focus mainly on epidemiological
aspects (Cai et al., 2014; Biswal et al., 2020; Brusa et al.,
2023), they lack insight into farmer satisfaction and the
perceived value of services, particularly in LMICs. By
assessing satisfaction as a factor in program success,
this study contributes a new, user-centered perspective,
providing insights that could improve public health
interventions for livestock. This study thus seeks
to evaluate FMD vaccination services by assessing
beef cale farmers’ satisfaction, identifying areas for
improvement, and exploring their perceptions of the
program’s benets.
METHODS
This research was conducted in Sleman Regency,
Special Region of Yogyakarta, which recorded the high-
est number of cases, with 8,333 cale infected and 545
dead (Ministry of Agriculture Indonesia, 2023). Primary
data were collected using a structured questionnaire
based on the research objectives. Respondents were
selected from districts with the highest cases in the
Sleman Regency, namely Cangkringan District, Ngaglik
District, and Sleman District (Ministry of Agriculture
Indonesia, 2023). This survey started from July 10, 2023,
to September 20, 2023, to obtain data from cale farmers
during the FMD outbreak period in Sleman Regency.
Data collection in this study employed a purposive sam-
pling technique, chosen specically to allow a targeted
selection of respondents who met the criterion of being
beef cale farmers in Sleman Regency, Special Region
of Yogyakarta, who had received FMD vaccination
services at least once during the vaccination phase. This
technique was selected to ensure that only farmers with
relevant experience of the vaccination program were
included, as their insights would directly relate to the
study’s objectives. Due to the unknown population of
FMD-aected beef cale farmers in Sleman Regency, the
minimum number of respondents was chosen following
the theory of Hair et al. (2018), where the sample size is
in the range of 100 to 200 respondents to obtain more
reliable results.
A total of 120 respondents were interviewed
face-to-face using a structured questionnaire, which
was validated through expert review in veterinary
public health and social research to ensure that items
accurately represented the constructs of interest.
Pearson correlation was applied to conrm internal
consistency and item relationships. The questionnaire
covered socio-demographic proles, perceptions
of FMD vaccination benets, and satisfaction with
vaccination services, rened based on established scales
and research standards.
First, the survey collected socio-demographic
proles such as gender, age, formal education, informal
education, number of livestock, farming experience, and
farmer group membership. Second, farmers’ perceptions
of the benets of the FMD vaccination program
were evaluated with 5 statement items using 5-point
Likert scale, namely 1-Strongly Disagree, 2-Disagree,
3-Undecided, 4-Agree, and 5-Strongly Agree, the Likert
scale is applied as one of the most basic and frequently
used psychometric tools in social science research ( Joshi
et al., 2015). Third, farmer satisfaction was measured
using the Customer Satisfaction Index (CSI) method.
The Customer Satisfaction Index (CSI) is a key method
for measuring satisfaction levels (customer expectation,
perceived service quality, and perceived value),
providing quantitative data in the form of percentage
scores (Anderson & Fornell, 2000; Hsu, 2008) by
applying the 5-point Likert scale starting with 1-Very
Unimportant, 2-Unimportant, 3-Neutral, 4-Important,
and 5-Very Important to scoring importance/expectation
and 1-Very Dissatised, 2-Dissatised, 3-Neutral,
4-Satised, and 5-Very Satised to scoring performance/
reality. This method follows the approach proposed by
a previous study on customer satisfaction (Qazi et al.,
2017).
Based on the principles of service delivery outlined
in the Minister of Administrative and Bureaucratic
Reform Decree No. 63/KEP/M.PAN/7/2003 regarding
general guidelines for public service implementation,
14 aributes have been developed as relevant, valid,
and reliable components for measuring beef cale
farmers’ satisfaction. These aributes, which serve
as the minimum standards for evaluating the Public
Satisfaction Index, include procedures, requirements,
clarity, discipline, responsibility, competence, speed,
fairness, courtesy, cost fairness, cost certainty, schedule
certainty, comfort, and security, as detailed in Table 1.
In conjunction, the Importance-Performance Analysis
(IPA), as proposed by Martilla & James (1977), is used
to assess the importance and performance of specic
program aributes. Customer satisfaction research
often examines either the importance of aributes or
performance, but not both. Measuring both dimensions
was suggested for a more accurate assessment (Martilla
& James, 1977; Maler et al., 2003).
Data were analyzed using SPSS 25.0 and Excel 2019.
To calculate the Customer Satisfaction Index (CSI), we
apply the following methodological steps:
First, we determine the Mean Importance Score
(MIS) and the Mean Satisfaction Score (MSS) for each
indicator. The MIS reects the average importance
assigned to each indicator by respondents, calculated
by summing the importance scores for a specic
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SYIHABUDDIN ET AL. / Tropical Animal Science Journal 48(1):83-92
indicator (n) across all respondents and dividing by
the total number of respondents (Yij). Similarly, the
MSS represents the average satisfaction level for each
indicator, obtained by summing the satisfaction scores
(Xij) across respondents and dividing by n. Formally,
MIS and MSS are represented as follows:
(1)
(2)
(3)
(4)
(5)
(1)
Where i is the indicator being evaluated, n is the
number of respondents, Yij is the importance score
for indicator i given by respondent j and Xij is the
corresponding satisfaction score. After determining
the MIS, we calculate the Weight Factor (WF) for each
indicator. This factor represents the relative importance
of each indicator by calculating the percentage that each
indicator’s MIS contributes to the sum of all MIS values
across indicators and then multiplying by 100% to
express it as a percentage. This calculation is expressed
as:
(1)
(2)
(3)
(4)
(5)
(2)
Where p is the total number of indicators and
(1)
(2)
(3)
(4)
(5)
is the sum of all MIS values. Once the WF is established,
the Weight Score (WS) for each indicator is determined
by multiplying its WF by the corresponding MSS.
This weighted score represents the contribution of
each indicator to the overall satisfaction level and is
calculated as:
(1)
(2)
(3)
(4)
(5)
(3)
Subsequently, the Weight Total (WT) is obtained by
summing the WS values of all indicators, providing an
aggregate measure of satisfaction that integrates both
importance and satisfaction across all indicators under
consideration:
(1)
(2)
(3)
(4)
(5)
(4)
Finally, the Customer Satisfaction Index (CSI) is
calculated by dividing the Weight Total (WT) by the
nominal scale used for satisfaction measurement (in
this case, a 5-point Likert scale) and then multiplying
by 100%. The result is a satisfaction index expressed
as a percentage, ranging from 0% to 100%, providing
an overall measure of satisfaction based on the
Table 1. The denition of beef cale farmers’ satisfaction aributes
No Aributes Denition
1 Procedures The clarity and simplicity of the steps required to obtain the service. Indicator: (1.1) The procedures
for providing services are designed to be easily understandable.
2 Requirements The ease of fullling the necessary conditions for receiving the service.
Indicator: (2.1) The requirements for services are readily fullled.
3 Clarity The eectiveness of the ocers in providing clear information. Indicators: (3.1) The ocers use
language and terminology that are easily understandable to farmers, and information related to foot
and (3.2) mouth disease (FMD) is communicated clearly.
4Discipline The punctuality and orderliness of ocers in carrying out their duties. Indicator: (4.1) Ocers
execute their responsibilities with discipline and professionalism.
5 Responsibility The accountability and reliability of ocers in performing their tasks. Indicator: (5.1) Ocers ensure
that all farmers receive vaccination services as required.
6 Competence The ability of ocers to carry out their roles eciently and professionally. Indicator: (6.1) Ocers
demonstrate procient skills in administering vaccinations.
7 Speed The timeliness and promptness in delivering the service. Indicators: (7.1) Ocers address farmers’
complaints promptly and (7.2) the vaccination process is conducted eciently and without
interruptions.
8 Fairness Equal treatment for all recipients without discrimination. Indicators: (8.1) Ocers deliver equitable
and fair treatment to all farmers and (8.2) ocers do not discriminate based on the locations of
farmers’ barns.
9 Courtesy The politeness and positive aitude shown by ocers. Indicator: (9.1) Ocers maintain a polite and
friendly demeanor towards farmers.
10 Cost fairness The fairness and transparency of the costs associated with the service. Indicator or: (10.1) There is a
guarantee that no hidden fees or non-transparent vaccination rates are applied, ensuring openness.
11 Cost certainty Assurance that the fees remain xed and clear. Indicators: (11.1) Cost information remains stable
and is not subject to sudden changes and (11.2) vaccination costs are consistent throughout dierent
FMD vaccination periods.
12 Schedule certainty The reliability of service hours and availability. Indicators: (12.1) Services are delivered in accordance
with the predetermined schedule and (12.2) ocers inform farmers of any alterations to the service
schedule.
13 Comfort The physical and psychological comfort of the service seing. Indicator: (13.1) Ocers demonstrate a
concern for the comfort of livestock.
14 Security The assurance that the service provided is safe from risks or harm. Indicators: (14.1) Ocers
exhibit expertise in handling livestock during the vaccination process and (14.2) ocers adhere to
biosecurity procedures during vaccinations.
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SYIHABUDDIN ET AL. / Tropical Animal Science Journal 48(1):83-92
respondents’ evaluations, The formula for this step is
expressed as:
(1)
(2)
(3)
(4)
(5)
(5)
The Importance-Performance Analysis (IPA)
provides a structured approach to evaluate the
relationship between the importance and satisfaction
levels for each indicator, facilitating the prioritization
of areas for improvement and resource allocation. The
analysis is conducted by ploing the Mean Importance
Score (MIS) and Mean Satisfaction Score (MSS) for each
indicator on a two-dimensional graph. The horizontal
axis represents satisfaction (MSS), while the vertical
axis represents importance (MIS). The graph is divided
into four quadrants based on the average MIS and
MSS values, allowing indicators to be categorized into
specic priority levels.
Quadrant I (Main Priority) contains indicators
with high importance (MIS above the average) but
low performance (MSS below the average). These
are critical areas where performance does not meet
respondents’ expectations, making them the top priority
for improvement. Quadrant II (Keep Up the Good
Work) includes indicators of both high importance
and high performance (MIS and MSS are above the
average). These areas represent the strengths of the
service, and their performance should be maintained
to ensure continued satisfaction. Quadrant III (Low
Priority) contains indicators with low importance and
low performance (MIS and MSS below the average),
suggesting that these areas are less concerned to
respondents and may not require immediate aention.
Finally, Quadrant IV (Possible Overkill) includes
indicators with low importance but high performance
(MIS below the average, MSS above the average).
These areas indicate potential overinvestment, as the
performance level exceeds respondents’ expectations
relative to the importance assigned to the indicators. An
explanation of the variable denitions used in this study
can be seen in full in Table 2.
RESULTS
The Description of Demographic Characteristics of
Beef Cale Farmers
The socio-economic characteristics of beef cale
farmers in this study reveal several key insights. The
respondents were predominantly male, comprising 95%
of the sample, and primarily of productive age, with
an average age of 54.47±12.74 years. On the education
front, the respondents had an average of 9.64±2.94
years of formal education. The majority of respondents
have completed high school (37.50% or 45 individuals),
followed by elementary school graduates at 29.10%
and junior high school graduates at 27.50%. Notably,
58.30% of the respondents indicated that they had not
aended any training related to beef cale farming
or participated in extension programs addressing the
FMD outbreak and its vaccination. In terms of farming
experience, the respondents averaged 20±13.19 years,
with the largest percentage (45.83%) being in the 11-20
year range. The average herd size was 2.35±1.31 cale,
and a signicant majority (82.50%) owned between
1 and 3 beef cale. Furthermore, 100 respondents,
representing 83.33%, were members of farmers’ groups,
while 20 respondents, comprising 16.67%, had not yet
joined such groups.
Customer Satisfaction Index (CSI) and Importance-
Performance Analysis (IPA)
The average importance and performance scores
were analyzed using the Customer Satisfaction Index
(CSI) to quantify farmers’ satisfaction levels with
FMD vaccination services. The CSI results will then be
translated into a Cartesian diagram using Importance
Table 2. Operational denition of research
No Variables Denition
1Beef cale famers’ satisfaction The evaluation of Beef cale farmers compares the outcomes they receive with their desired
expectations. In this study, the Customer Satisfaction Index (CSI) is used to measure overall
Beef cale farmers’ satisfaction, encompassing an assessment based on the average scores of
both importance and performance across public service indicators. The performance variable
is measured using the likert scale: 1=very dissatised, 2=dissatised, 3=neutral, 4=satised,
and 5=very satised. Meanwhile, the importance variable is assessed using the categories:
1=very unimportant, 2=unimportant, 3=neutral, 4=important, and 5=very important.
2 Demographic characteristics
Age The age of beef cale farmers from the date of their born to the last birthday.
Formal education The education of beef cale farmers in the school (1=primary school, 2=secondary school,
3=high school, 4=bachelor).
Informal education The frequency that beef cale farmers joined in training, meetings, and conference (1=yes,
0=not yet).
Farming experience Experience of the beef cale farmer in the livestock business in the years.
Cale herd size The number of cale in farmer’s farm.
Farmers’ group membership The status of whether or not a beef cale farmer is part of a livestock group (1=yes, 0=not
yet).
3Perception of the benets of
the vaccination program
Beef cale farmers’ views and understanding of the advantages gained from participating in
a vaccination program (likert scale).
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Performance Analysis (IPA). This analysis will provide
deeper insight into how well the actual performance of
FMD vaccination services meets farmers’ expectations,
identifying gaps between these expectations and the
perceived service performance. This approach helps
pinpoint both areas where the service meets expecta-
tions and those requiring improvement. The ndings
oer valuable guidance for both government regulators
and service ocers to enhance the eectiveness and
relevance of future vaccination programs, ensuring
they beer meet farmers’ needs. The CSI results are pre-
sented in Table 3, and the IPA diagram in Figure 1.
Based on Table 3, the Mean Importance Score
(MIS) and Mean Satisfaction Score (MSS) for each
aribute are identied. The MIS represents the average
importance score for an aribute, while the MSS is the
average satisfaction score for that aribute. Based on
this calculation, the CSI index is 82.25%. According to
the satisfaction index criteria by Irawan (2007), an index
score of 82.25% falls into the “very satised” category.
In the Importance-Performance Analysis (IPA),
Quadrant I represents the main priority area, featuring
aributes that farmers consider highly important but
where performance falls short of their expectations.
Table 3. Customer satisfaction idex (CSI) calculation results for beef cale farmers on the foot and mouth disease vaccination services
Code Indicators MIS MSS WF WS
1.1 The procedures for providing services are designed to be easily
understandable.
4.23 3.66 5.027 18.391
2.1 The requirements for services are readily fullled. 4.19 3.63 4.988 18.080
3.1 Ocers utilize language and terminology that are easily comprehensible to
farmers.
3.99 4.00 4.750 18.999
3.2 Information related to Foot and Mouth Disease (FMD) is communicated
clearly.
4.16 4.33 4.948 21.441
4.1 Ocers execute their responsibilities with discipline and professionalism. 4.29 4.31 5.107 22.001
5.1 Ocers ensure that all farmers receive vaccination services as required. 4.16 4.16 4.948 20.575
6.1 Ocers demonstrate procient skills in administering vaccinations. 4.26 4.32 5.067 21.872
7.1 Ocers address farmers’ complaints promptly. 4.14 4.29 4.928 21.150
7.2 The vaccination process is conducted eciently and without interruptions. 4.15 4.32 4.938 21.316
8.1 Ocers deliver equitable and fair treatment to all farmers. 4.34 4.28 5.166 22.128
8.2 Ocers do not discriminate based on the locations of farmers’ barns. 4.31 4.03 5.126 20.677
9.1 Ocers maintain a polite and friendly demeanor towards farmers. 4.26 4.32 5.067 21.872
10.1 There is a guarantee that no hidden fees or non-transparent vaccination
rates are applied, ensuring openness.
4.25 4.40 5.057 22.251
11.1 Cost information remains stable and is not subject to sudden changes. 4.11 4.12 4.888 20.124
11.2 Vaccination costs are consistent throughout dierent FMD vaccination
periods.
4.00 4.34 4.760 20.664
12.1 Services are delivered in accordance with the predetermined schedule. 4.21 4.22 5.007 21.115
12.2 Ocers inform farmers of any alterations to the service schedule. 4.26 4.37 5.067 22.126
13.1 Ocers demonstrate a concern for the comfort of livestock. 4.17 4.72 4.958 23.385
14.1 Ocers exhibit expertise in handling livestock during the vaccination
process.
4.33 3.23 5.146 16.640
14.2 Ocers adhere to biosecurity procedures during vaccinations. 4.25 3.25 5.057 16.435
Weight Total 411.241
Figure 1. Importance-Performance Analysis (IPA) results of beef cale farmers' satisfaction with foot and mouth dis-
ease vaccination services
TASJ-59199
31
1
Figure 1. Importance Performance Analysis (IPA) result. 11
1
Performance/Reality (X)
Importance/Expectation (Y)
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Aributes in this quadrant require greater aention
and improvement to enhance farmer satisfaction. Based
on Figure 1, Quadrant I includes: “the procedures
for providing services are designed to be easily
understandable”, “ocers do not discriminate based
on the locations of farmers’ barns”, “ocers exhibit
expertise in handling livestock during the vaccination
process”, and “ocers adhere to biosecurity procedures
during vaccinations.”
Beef Cale Farmers’ Perceptions of the Benets of the
FMD Vaccination Program
Beef cale farmers’ perceptions of the benets
of the FMD vaccination program, as detailed in Table
4 have an index score of 83.8%, indicating a “very
good” rating. This positive evaluation is supported
by their responses to specic statements: “I believe
that this vaccination program can reduce the risk of
foot and mouth disease in my beef cale” (85.8%);
“This vaccination program assists me in adapting to
changes in policies and regulations related to beef
cale farming” (82.8%); “I believe that this vaccination
program helps me address the nancial challenges
that may arise from foot and mouth disease in my beef
cale” (83.6%); “I feel that this vaccination program
aids me in adapting to new innovations and practices
in disease management for beef cale” (81.6%); and
“I believe that this vaccination program supports
the long-term sustainability of my livestock farming
business” (85%). These high ratings reect beef cale
farmers’ strong understanding and awareness of the
benets of FMD vaccination. Their recognition of the
program’s importance highlights its role in protecting
livestock health, enhancing productivity, and ensuring
the sustainability of their farming operations. This
awareness is crucial for the successful implementation
of vaccination programs and the overall health of the
livestock sector.
DISCUSSION
Beef Cale Farmers’ Satisfaction towards FMD
Vaccination Services
The FMD vaccination is a national program in
Indonesia designed to strengthen livestock immunity
against Foot and Mouth Disease. This initiative aligns
with the Government Regulation of the Republic
of Indonesia No. 47 of 2014 on the Control and
Management of Animal Diseases. The implementation
of the program follows the Minister of Agriculture’s
Decree No. 517/KPTS/PK.300/M/7/2022, which revises
the earlier Decree No. 510/KPTS/PK.300/M/6/2022
on FMD Vaccination. The primary objective of the
program is to immunize cale to prevent the onset
of the disease and eectively reduce the risk of
transmission between animals (Directorate General
of Livestock and Animal Health, 2022). Historically,
the successful implementation of FMD vaccination in
Indonesia played a crucial role in controlling the 1986
outbreak (Directorate General of Livestock and Animal
Health, 2022). This success underscores the strategic
importance of vaccination in safeguarding the health
and sustainability of the livestock sector.
This evaluation is guided by the Decree of the
Minister of Administrative and Bureaucratic Reform No.
63/KEP/M.PAN/7/2003 (Ministry of Administrative and
Bureaucratic Reform, 2003). According to Wijaya (2011),
service quality reects how well a service meets custom-
er expectations. Kotler & Keller (2016) dene customer
satisfaction as the individual’s feelings after comparing
their expectations with the actual service performance.
Satisfaction arises from positive disconrmation, which
occurs when the outcomes received exceed expectations,
while dissatisfaction results from negative disconrma-
tion, meaning that the outcomes fall short of expecta-
tions (Chen et al., 2018; Nam et al., 2020; Zamani &
Pouloudi, 2021; Mazhar et al., 2022; Zhang et al., 2022).
This satisfaction or dissatisfaction, as noted by Kotler
and Keller (2016), can shape future behaviors and inu-
ence continued participation. The high level of satisfac-
tion among beef cale farmers regarding the FMD vac-
cination services indicates that the program eectively
meets their needs and expectations. However, further
analysis using the Importance-Performance Analysis
(IPA) reveals several areas for improvement. Addressing
these points will be essential for enhancing the overall
eectiveness of the vaccination program in the future.
According to Figure 1, indicator 1.1 (the
procedures for providing services are designed
to be easily understandable) highlights that FMD
vaccination registration is managed by farmer group
leaders. These leaders are key in building trust and
Table 4. Beef cale farmers' perceptions on the benet of foot and mouth disease vaccination
No Statement Mean Category
1I believe that this vaccination program can reduce the risk of foot and mouth disease in my
beef cale.
4.29 Very Good
2 This vaccination program assists me in adapting to changes in policies and regulations
related to beef cale farming.
4.14 Very Good
3I believe that this vaccination program helps me address the nancial challenges that may
arise from foot and mouth disease in my beef cale.
4.18 Very Good
4I feel that this vaccination program aids me in adapting to new innovations and practices in
disease management for beef cale.
4.08 Very Good
5I believe that this vaccination program supports the long-term sustainability of my livestock
farming business.
4.25 Very Good
Mean 4.19 Very Good
Note: Primary data (2024).
January 2025 89
SYIHABUDDIN ET AL. / Tropical Animal Science Journal 48(1):83-92
facilitating communication between farmers and
vaccination ocers, contributing to the program’s
success. While farmers nd the socialization during
group meetings clear, they feel less satised due to
limited direct involvement in the service process. In the
aribute of service fairness, there is a specic indicator
requiring improvement: indicator 8.2 (Ocers do not
discriminate based on the locations of farmers’ barns),
eld interviews reveal that some farmers perceive that
ocers prioritize barns in easily accessible locations or
those closer to the Puskeswan (animal health center).
The limited number of Animal Health Workers (AHWs)
at each Puskeswan—typically only two (a veterinarian
and a paramedic)—highlights the need for evaluation.
The quantity of sta is as crucial as their quality,
especially during emergencies such as an FMD outbreak
when numerous complaints that should be addressed
promptly are delayed. This aligns with Sa’adah et al.
(2019), who assert that the distribution of Animal Health
Workers (AHWs) within a working area should consider
the number of beneciaries and the area size to ensure
equitable service delivery.
In the evaluation of the security aributes of the
vaccination service, two key indicators were assessed.
The rst, Indicator 14.1, pertains to the skill of Animal
Health Workers (AHWs) in handling livestock, which
farmers have rated as insucient. This dissatisfaction
arises because farmers are often required to handle
their own animals during the vaccination process. This
situation is further inuenced by the limited number
of AHWs available, necessitating farmers’ assistance in
tasks that ideally should be managed by more trained
personnel. The second indicator, 14.2, measures the
adherence of Animal Health Workers (AHWs) to
biosecurity procedures. Biosecurity refers to eorts
aimed at protecting livestock and reducing the risk of
disease spread that negatively impacts animals (Sari
et al., 2023), eective implementation of biosecurity
protocols, including proper Personal Protective
Equipment (PPE) usage, is critical for maintaining
trust in the FMD vaccination program and ensuring
the safety of livestock. Although the use of Personal
Protective Equipment (PPE) by AHWs has generally
been well-implemented, a signicant issue is the lack
of discipline in changing PPE when moving from one
group of livestock to another during vaccination. This
oversight has led to complaints from farmers regarding
previously healthy animals becoming ill following
vaccination visits. Addressing the importance of
An adverse event following immunization (AEFI) is
crucial for maintaining animal health and fostering
farmer trust. AEFI is dened as any untoward medical
occurrence following immunization which does not
necessarily have a causal relationship to the vaccine
(WHO, 2012). Enhancing PPE discipline and improving
understanding of AEFI are essential steps toward
making veterinary services more eective and secure for
all stakeholders involved.
This perspective is reinforced by Athambawa et al.
(2021), who emphasize the critical need for educating
the public about the identication, transmission, and
management of Foot and Mouth Disease (FMD), as
well as the benets of vaccination. Some farmers hold
misconceptions that FMD vaccines cause abortions at
any stage of pregnancy, reduce milk production, or even
harm the animals. They also believe that FMD does not
lead to death and can be treated with antibiotics rather
than vaccines. In some rural areas, traditional methods
are used for treating FMD-infected animals, and the
use of antibiotics during FMD outbreaks has also been
documented in other developing nations (Nampanya
et al., 2016; Young et al., 2017). To overcome these
misconceptions and increase vaccine acceptance, it is
crucial to implement regular training programs that
address these issues and raise awareness among rural
farmers (Rezvanfar, 2007).
Beef Cale Farmers’ Perceptions of the Benets of the
Vaccination Program
Beef cale farmers generally perceive the
FMD vaccination program positively, recognizing
its benets for livestock health and demonstrating
strong knowledge and condence in its eectiveness.
This positive perception underscores the program’s
signicant role in supporting livestock health,
improving productivity, and ensuring farming
sustainability. Animal Health Workers (AHWs),
including veterinarians and paramedics, have
established strong relationships with farmers through
regular monitoring and service delivery, enabling a
smoother adaptation to new information during the
FMD outbreak. Eective communication between
farmers and AHWs is critical for optimizing vaccination
strategies, as it provides farmers with essential
knowledge on disease prevention and treatment (Hall &
Wapenaar, 2012; Qui et al., 2021; Athambawa et al., 2021;
Guntoro et al., 2023).
This study’s ndings align with prior research
indicating that participation in livestock management
training signicantly enhances farmers’ knowledge
about FMD (Athambawa et al., 2021). Access to
extension services is also pivotal in technology adoption
and informed decision-making. Additionally, informal
education and extension services provided valuable
information (Guntoro et al., 2016). Extension services
deliver timely and pertinent information that helps
farmers address agricultural challenges and make more
informed decisions about their farming practices (Qui et
al., 2021; Kassem et al., 2021).
However, it is important to note that farmers’
understanding and acceptance of FMD vaccination
can be undermined by the spread of misinformation or
disinformation. Broader outbreaks or pandemics often
exacerbate the dissemination of disinformation, which
negatively aects public trust in scientic knowledge
and policy implementation (De Figueiredo et al., 2020).
Therefore, in addition to promoting the ecacy of
vaccines, governments and stakeholders must actively
counter misinformation. In this context, farmer groups
can play a critical role in disseminating accurate infor-
mation and providing farmers with a clear understand-
ing of vaccination benets. A strategic communication
approach through these groups can enhance vaccine
90 January 2025
SYIHABUDDIN ET AL. / Tropical Animal Science Journal 48(1):83-92
acceptance and signicantly contribute to the success of
vaccination programs (Sok & Fischer, 2020).
Research has consistently shown that group
activities and membership are key factors inuencing
farmers’ engagement and commitment to their social
networks (Haryadi et al., 2019). Membership in
such groups fosters social capital by building trust,
facilitating idea exchange, and enhancing information
sharing (Ganguly et al., 2019). Social networks play
a crucial role in agricultural innovation, as farmers
share knowledge and learn from one another (Ouya
et al., 2022). Guntoro et al. (2016) also highlighted the
importance of peer networks, where fellow farmers
and friends are key sources of reliable information.
This is consistent with the theory of goal aainment,
which suggests that actions taken by individuals or
groups aim to achieve objectives across interconnected
systems (Kiresuk et al., 2014). Consequently, the role of
farmer groups is essential not only for fostering trust
in the vaccination program but also for countering
disinformation that could be detrimental.
CONCLUSION
This study found that beef cale farmers’ overall
satisfaction with the program stands at 82.25%,
reecting a positive evaluation. Beef cale farmers
generally perceive the foot and mouth disease
(FMD) vaccination program as highly benecial,
with ve key indicators—condence in vaccination
eectiveness, policy and regulatory support, nancial
aid, adaptation to disease management innovations,
and sustainability of livestock farming—being well-
understood and accepted, with an overall perception
rating of 83.8%. To enhance the program's eectiveness,
urgent improvements in service performance are
needed. Priority areas include simplifying service
procedures, ensuring equitable treatment regardless
of farm location, strengthening ocer handling
skills, and correctly applying biosecurity measures.
Additionally, increasing the number of animal health
workers (AHWs) is crucial for delivering timely and
comprehensive services, especially during outbreaks.
Further research should address access, logistical
challenges, and ways to improve farmer engagement,
which are essential to advancing vaccination programs
and promoting sustainable agricultural practices.
CONFLICT OF INTEREST
We declare that there is no conict of interest with
nancial, personal, or other relationships with other
people or organizations related to the material discussed
in the manuscript.
ACKNOWLEDGEMENT
We would like to acknowledge the nancial
support provided in 2023 from the Departement of
Livestock Social Economics of the Faculty of Animal
Science, Gadjah Mada University, Yogyakarta.
REFERENCES
Adjid, R. A. (2020). Foot and mouth disease: an exotic animal
disease that must be alert of entry into Indonesia.
WARTAZOA, 30(2), 61-70. hps://doi.org/10.14334/
wartazoa.v30i2.2490
Anderson, E. W., & Fornell, C. (2000). Foundations of the American
customer satisfaction index. Total Quality Management,
11(7), 869-882. hps://doi.org/10.1080/09544120050135425
Athambawa, M. J., Kubota, S., & Kono, H. (2021). Knowledge
aecting foot-and-mouth disease vaccination behavior:
traditional dairy farmers in the dry zone of Sri Lanka.
Tropical Animal Health Production, 53, 1-8. hps://doi.
org/10.1007/s11250-020-02501-5
Biswal, J. K., Subramaniam, S., Ranjan, R., VanderWaal, K.,
Sanyal, A., Panaik, B., & Singh, R. K. (2020). Dierential
antibody responses to the major antigenic sites of FMD virus
serotype O after primo-vaccination, multiply-vaccination
and after natural exposure. Infection Genetics Evolution,
78, 104105. hps://doi.org/10.1016/j.meegid.2019.104105
Brusa, V., Durrieu, M., Van Gelderen, C. J., Signorini, M. L., &
Schudel, A. (2023). Quantitative risk assessment of FMDV
introduction in a FMD free country through bone-in beef
and oal importation from a FMD free with vaccination
country/zone. Preventive Veterinary Medicine, 218,
105995. hps://doi.org/10.1016/j.prevetmed.2023.105995
Cai, C., Li, H., Edwards, J., Hawkins, C., & Robertson, I. D.
(2014). Meta-analysis on the ecacy of routine vaccination
against foot and mouth disease (FMD) in China.
Preventive Veterinary Medicine, 115(3-4), 94-100. hps://
doi.org/10.1016/j.prevetmed.2014.03.020
Campbell, Z. A., Otieno, L., Shirima, G. M., Marsh, T. L., &
Palmer, G. H. (2019). Drivers of vaccination preferences
to protect a low-value livestock resource: Willingness
to pay for Newcastle disease vaccines by smallholder
households. Vaccine, 37(1), 11-18. hps://doi.org/10.1016/j.
vaccine.2018.11.058
Chen, T., Ma, K., Bian, X., Zheng, C., & Devlin, J. (2018). Is
high recovery more eective than expected recovery
in addressing service failure? — A moral judgment
perspective. Journal of Business Research, 82, 1–9. hps://
doi.org/10.1016/j.jbusres.2017.08.025
De Figueiredo, A., Simas, C., Karallakis, E., Paterson, P., &
Larson, H. J. (2020), Mapping global trends in vaccine
condence and investigating barriers to vaccine uptake:
a large-scale retrospective temporal modelling study.
Lancet, 396(10255), 898-908. hps://doi.org/10.1016/
S0140-6736(20)31558-0
Directorate General of Livestock and Animal Health. (2022).
Indonesia veterinary emergency preparedness series: foot
and mouth disease 2022. Directorate General of Livestock
and Animal Health, Ministry of Agriculture. Republic of
Indonesia.
Food and Agriculture Organization. (2017). Livestock solutions
for climate change. Retrieved February 14, 2024 from
hp://www.fao.org/3/I8098EN/i8098en.pdf.
Food and Agriculture Organization. (2018). The global foot and
mouth disease control Strategy. Retrieved February 14,
2024 from hp://www.fao.org/ag/againfo/programmes/
en/empres/disease_fmd.asp,pdf.
Ganguly, A., Talukdar, A., & Chaerjee, D. (2019). Evaluating the
role of social capital, tacit knowledge sharing, knowledge
quality and reciprocity in determining innovation
capability of an organization. Journal of Knowledge
Management, 23(6), 1105-1135. hps://doi.org/10.1108/
JKM-03-2018-0190
Guntoro, B., Subejo, & Sazali, H. (2016). Information access
capability of goat farmers in Purworejo Indonesia.
Information, 19, 1819-1826.
January 2025 91
SYIHABUDDIN ET AL. / Tropical Animal Science Journal 48(1):83-92
Guntoro B., Triatmojo, A., Ariyadi, B., & Qui, N. H. (2023).
Risk analysis in cale farmers’ prevention practices
of anthrax and foot and mouth disease in yogyakarta
province, Indonesia. Advances in Animal and Veterinary
Sciences 11(6), 987-997. hps://doi.org/10.17582/journal.
aavs/2023/11.6.987.997
Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2018).
Multivariate data analysis (8th ed.). Cengage Learning.
Hall, J., & Wapenaar, W. (2012). Opinions and practices of
veterinarians and dairy farmers towards herd health
management in the UK. Veterinary Record, 170(17), 441-
441. hps://doi.org/10.1136/vr.100318
Haryadi, F. T., Widiati, R., Kusumastuti, T. A., & Andarwati, S.
(2019). Beef cale farmers’ group cohesion in Bantul and
Sleman Regencies Yogyakarta special region, Indonesia.
Journal of Agricultural Extension, 23(1), 223-229. hps://
doi.org/10.4314/jae.v23i1.19
Hopker, A., Pandey, N., Bartholomew, R., Blanton, A., Hopker,
S., Dhamorikar, A., Goswami, J., Marsland, R., Metha, P.,
& Sargison, N. (2021). Livestock vaccination programme
participation among smallholder farmers on the outskirts
of National Parks and Tiger Reserves in the Indian states of
Madhya Pradesh and Assam. PLoS ONE, 16(8), e0256684.
hps://doi.org/10.1371/journal.pone.0256684
Hsu, S. H. (2008). Developing an index for online customer
satisfaction: adaptation of American customer satisfaction
index. Expert Systems with Applications, 34(4), 3033-3042.
hps://doi.org/10.1016/j.eswa.2007.06.036
Irawan, H. 2007. 10 Prinsip kepuasan pelanggan (9th ed.). PT.
Elex Media Komputindo Kelompok Gramedia.
Jamal, S. M., & Belsham, G. J. (2013). Foot-and-mouth disease:
past, present and future. Veterinary Research, 44, 116.
hps://doi.org/10.1186/1297-9716-44-116
Joshi, A., Kale, S., Chandel, S., & Pal, D. (2015). Likert scale:
explored and explained. Current Journal of Applied
Science and Technology, 7(4), 396–403. hps://doi.
org/10.9734/BJAST/2015/14975
Kassem, H. S., Alotaibi, B. A., Muddassir, M., & Herab, A.
(2021). Factors inuencing farmers’ satisfaction with the
quality of agricultural extension services. Evaluation and
Program Planning, 85, 101912. hps://doi.org/10.1016/j.
evalprogplan.2021.101912
Kotler, P., & Keller, K. L. (2016). Marketing management (15th
Global Edition). Edinburgh gate: Pearson education
limited.
Kiresuk, T. J., Smith, A., & Cardillo, J. E. (2014). Goal aainment
scaling: applications, theory, and measurement (1st ed.)
Psychology Press. hps://doi.org/10.4324/9781315801933
Matondang, R. H., & Rusdiana, S. (2014). Langkah-langkah
strategis dalam mencapai swasembada daging sapi/
kerbau 2014. Jurnal Penelitian Pengembangan Pertanian,
32(3), 131-139.
Maler, K., Sauerwein, E., & Heischmidt, K. (2003). Importance-
performance analysis revisited: the role of the factor
structure of customer satisfaction. The Service Industries
Journal, 23(2), 112-129. hps://doi.org/10.1080/0264206041
2331300912
Mazhar, M., Ting, D. H., Abbasi, A. Z., Nadeem, M. A., & Abbasi,
H. A. (2022). Gauging customers’ negative disconrmation
in online post-purchase behaviour: The moderating role of
service recovery. Cogent Business & Management, 9(1),
2072186. hps://doi.org/10.1080/23311975.2022.2072186
Ministry of Administrative and Bureaucratic Reform. (2003).
Decree of the Minister of Administrative and Bureaucratic
Reform No. 63/KEP/M.PAN/7/2003 concerning General
Guidelines for the Administration of Public Services.
Ministry of Agriculture Indonesia. (2023). Information on
Foot and Mouth Disease Outbreak Countermeasures
and Precautions. Ministry of Agriculture of the Republic
of Indonesia. Retrieved December 15, 2023, from hps://
pusvetma.ditjenpkh.pertanian.go.id/crisiscenter.
Nam, K., Baker, J., Ahmad, N., & Goo, J. (2020). Dissatisfaction,
disconrmation, and distrust: An empirical examination
of value co-destruction through negative electronic word-
of-mouth (eWOM). Information Systems Frontiers, 22,
113-130. hps://doi.org/10.1007/s10796-018-9849-4
Nampanya, S., Khounsy, S., Abila, R., Young, J. R., Bush, R. D.,
& Windsor, P. A. (2016). Financial impacts of foot-and-
mouth disease at village and national levels in Lao PDR.
Transboundary and Emerging Diseases, 63(5), e403-e411.
hps://doi.org/10.1111/tbed.12319
Nuvey, F. S., Fink, G., Haendorf, J., Mensah, G. I., Addo, K.
K., Bonfoh, B., & Zinsstag, J. (2023). Access to vaccination
services for priority ruminant livestock diseases in Ghana:
Barriers and determinants of service utilization by farmers.
Preventive Veterinary Medicine, 215, 105919. hps://doi.
org/10.1016/j.prevetmed.2023.105919
Rezvanfar, A. (2007). Communication and socio-personal
factors inuencing adoption of dairy farming technologies
amongst livestock farmers. Livestock Research Rural
Development, 19(3), 33. Retrieved September 15, 2023,
from hp://www.lrrd.org/lrrd19/3/rezv19033.htm
Rodriguez, L. L., & Grubman, M. J. (2009). Foot and mouth
disease virus vaccines. Vaccine, 27, D90-D94. hps://doi.
org/10.1016/j.vaccine.2009.08.039
Sa’adah, I., Mukson, M., & Ondho, Y. S. (2019). Pengukuran
tingkat kepuasan peternak dalam pelayanan inseminasi
buatan menggunakan analisis customer satisfaction index
(CSI) dan importance performance analysis (IPA). Jurnal
Ekonomi Pertanian Agribisnis, 3(3), 557-567. hps://doi.
org/10.21776/ub.jepa.2019.003.03.11
Santos, D. V. D., Silva, G. S. E., Weber, E. J., Hasenack, H.,
Gro, F. H. S., Todeschini, B., Borba, M. R., Medeiros, A.
A. R., Leoi V. B., Canal C. W., & Corbellini, L. G. (2017).
Identication of foot and mouth disease risk areas using
a multi-criteria analysis approach. PLoS ONE, 12(5),
e0178464. hps://doi.org/10.1371/journal.pone.0178464
Sargison, N. D. (2020). The critical importance of planned small
ruminant livestock health and production in addressing
global challenges surrounding food production and
poverty alleviation. New Zealand Veterinary Journal,
68(3), 136-144. hps://doi.org/10.1080/00480169.2020.1719
373
Sari, D. Y., Haryadi, F. T., Wibowo, M. H., Andarwarti, S., &
Suranindiyah, Y. Y. (2023). Community aitudes towards
biosecurity in animal based tourism. Jurnal Ilmu-Ilmu
Peternakan, 33(2), 240-250. hps://doi.org/10.21776/
ub.jiip.2023.033.02.11
Sok, J., & Fischer, E. A. (2020). Farmers’ heterogeneous motives,
voluntary vaccination and disease spread: an agent-based
model. European Review of Agricultural Economics, 47(3),
1201-1222. hps://doi.org/10.1093/erae/jbz041
Ouya, F. O., Be, E., Nguhiu, P., Makokha, S., & Mwirigi, M.
K. (2022). Agro pastoralists’ awareness and knowledge
on contagious caprine Pleuropneumonia in two selected
counties in Kenya. Cogent Food & Agriculture, 8(1),
hps://doi.org/10.1080/23311932.2022.2140472
Qazi, A., Tamjidyamcholo, A., Raj, R. G., Hardaker, G., &
Standing, C. (2017). Assessing consumers’ satisfaction and
expectations through online opinions: Expectation and
disconrmation approach. Computers in Human Behavior,
75, 450-460. hps://doi.org/10.1016/j.chb.2017.05.025
Qui, N. H., Guntoro, B., Syahlani, S. P., & Linh, N. T. (2021). Factor
aecting the information sources and communication
channels toward pig farmer’s perception of African swine
fever in Tra Vinh province, Vietnam. Tropical Animal
Science Journal, 44(2), 248-254. hps://doi.org/10.5398/
tasj.2021.44.2.248
92 January 2025
SYIHABUDDIN ET AL. / Tropical Animal Science Journal 48(1):83-92
Thomson, G. R., Vosloo, W., & Bastos, A. D. S. (2003). Foot and
mouth disease in wildlife. Virus Research, 91(1), 145-161.
hps://doi.org/10.1016/S0168-1702(02)00263-0
WHO. (2012). Weekly epidemiological record, No. 30, 2012, pp.
284–286. World Health Organization.
Widiati, R., Nurtini, S., Kusumastuti, T. A., Syahlani, S. P.,
& Muzayyanah, M. A. U. (2019). Performance and
economic incentives of cowcalf operation crossbred in the
smallholder cale in Yogyakarta-Indonesia. International
Journal of Business & Society, 20(1), Retrieved February
22, 2024, from hps://www.proquest.com/scholarly-
journals/performance-economic-incentives-cow-calf/
docview/2393120995/se-2
World Organization for Animal Health. (2018). World animal
health information system. WAHIS portal: a new era
for animal health data. Paris (FR): World Organization
for Animal Health. Retrieved February 22, 2024,
from hp://www.oie.int/wahis_2/public/wahid.php/
Countryinformation/Countrytimelines.
Win, T. T. Z., Campbell, A., Magalhaes, R. J. S., Oo, K. N., &
Henning, J. (2021). What drives small-scale farmers
to vaccinate their multiple livestock species animals
against common infectious diseases in Myanmar?. PLoS
ONE, 16(10), e0258765. hps://doi.org/10.1371/journal.
pone.0258765
Yemeke, T. T., Mitgang, E., Wedlock, P. T., Higgins, C., Chen,
H. H., Pallas, S. W., Abimbola, T., Wallace, A., Bartsch, S.
M., Lee, B. Y., & Ozawa, S. (2021). Promoting, seeking, and
reaching vaccination services: a systematic review of costs
to immunization programs, beneciaries, and caregivers.
Vaccine, 39(32), 4437-4449. hps://doi.org/10.1016/j.
vaccine.2021.05.075
Zamani, E. D., & Pouloudi, N. (2021). Generative mechanisms
of workarounds, discontinuance and reframing: a study
of negative disconrmation with consumerised IT.
Information Systems Journal, 31(3), 384–428. hps://doi.
org/10.1111/isj.12315
Zhang, J., Chen, W., Petrovsky, N., & Walker, R. M. (2022). The
expectancy-disconrmation model and citizen satisfaction
with public services: a meta-analysis and an agenda for
best practice. Public Administration Review, 82(1), 147–
159. hps://doi.org/10.1111/puar.13368